How can we make complex feeding decisions in stroke easier?

Abstract

Background Dysphagia (difficulty swallowing) is a common post-stroke complication, reported to affect almost half of stroke survivors. The management of dysphagia, particularly severe post stroke dysphagia, can be complex and fraught with ethical complexity.

Aims The aim of this project was to utilise a formal quality improvement cycle to demonstrate and evaluate the introduction of a decision-making support tool and framework for complex dysphagia decision making to support and guide speech pathologists.

Methods A quality improvement framework was applied to the development and evaluation of decision support tools for complex feeding. The decision support tools included introduction of standardised terminology, decision making flow charts, consent forms, patient and staff education resources and work place instructions

Results Evaluation of the tools showed that they were well received by the speech pathologists and broader hospital staff. Presentation of case examples will highlight the utilisation and benefits of decision making tools in the stroke population.

Conclusion/Discussion Decision making support tools in the area of complex dysphagia management were well received by clinicians and rapidly implemented. These tools may assist the multi-disciplinary team to make complex decisions which are medico-legally sound and in the best interest of the patients.